Park Yong Il, Yu Ji Hyeong, Sung Luck Hee, Noh Chung Hee, Chung Jae Yong
Department of Urology, Inje University College of Medicine, Seoul, Korea.
Korean J Urol. 2010 Oct;51(10):713-8. doi: 10.4111/kju.2010.51.10.713. Epub 2010 Oct 21.
The aim of this study was to evaluate possible predictive variables for the outcome of shock wave lithotripsy (SWL) of renal stones in a single center.
Between March 2008 and March 2010, a retrospective review was performed of 115 patients who underwent SWL for solitary renal stones. The patients' characteristics and stone size, location, skin-to-stone distance (SSD), and Hounsfield units (HU) of stone were reviewed. The impact of the possible predictors on the disintegration of the stones was evaluated by logistic regression analysis. Receiver operator characteristic (ROC) curves were generated to compare the predictive powers of the variables.
Seventy-nine patients (68.7%) had successful outcomes, whereas 36 patients (31.3%) had residual stones. Significant differences were found in the mean size and mean HU of the stones (size: 8.34±3.58 mm vs. 13.57±5.41 mm, p<0.001; HU: 675.29±254.34 vs. 1,075.00±290.41, p<0.001). In the unadjusted model, age, stone size, and stone density were significant predictors. In the reduced model, stone density and size were significant predictors for the outcome of SWL. The area under the ROC curve (AUC) was significantly higher for stone density and size than for the other parameters, but the AUC between stone density and size did not differ significantly (stone density: 0.874, stone size: 0.827, p=0.388).
Stone density and size were significant predictors of the outcome of SWL for renal stones less than 2.0 cm in diameter. We should consider HU and stone size when making decisions on the treatment of renal stones.
本研究旨在评估单中心肾绞痛冲击波碎石术（SWL）结果的可能预测变量。
2008年3月至2010年3月，对115例因孤立性肾结石接受SWL治疗的患者进行回顾性分析。回顾患者的特征、结石大小、位置、皮肤至结石距离（SSD）和结石的Hounsfield单位（HU）。通过逻辑回归分析评估可能的预测因素对结石崩解的影响。绘制受试者操作特征（ROC）曲线以比较各变量的预测能力。
79例患者（68.7%）治疗成功，36例患者（31.3%）有残余结石。结石的平均大小和平均HU存在显著差异（大小：8.34±3.58mm对13.57±5.41mm，p<0.001；HU：675.29±254.34对1075.00±290.41，p<0.001）。在未校正模型中，年龄、结石大小和结石密度是显著的预测因素。在简化模型中，结石密度和大小是SWL结果的显著预测因素。结石密度和大小的ROC曲线下面积（AUC）显著高于其他参数，但结石密度和大小之间的AUC无显著差异（结石密度：0.874，结石大小：0.827，p=0.388）。
结石密度和大小是直径小于2.0cm肾结石SWL结果的显著预测因素。在决定肾结石治疗方案时，应考虑HU和结石大小。
